Sleeves, manifolds, systems, and methods for applying reduced pressure to a subcutaneous tissue site

ABSTRACT

The illustrative embodiments described herein are directed to apparatuses, systems, and methods for applying reduced pressure to subcutaneous tissue site. In one illustrative embodiment, the apparatus includes a sleeve adapted for placement at a subcutaneous tissue site. The sleeve is further adapted to receive a manifold. The sleeve may also have an opening operable to transfer reduced pressure from the manifold to the subcutaneous tissue site. In one embodiment, the apparatus may also include a manifold that is insertable into the sleeve. The manifold may include at least one aperture, and may be operable to deliver reduced pressure to the subcutaneous tissue site via at least one aperture.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.61/141,716, filed Dec. 31, 2008, which is hereby incorporated byreference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present application relates generally to medical treatment systems,and more particularly, to a reduced pressure treatment system and methodfor applying reduced pressure to a tissue site.

2. Description of Related Art

Clinical studies and practice have shown that providing a reducedpressure in proximity to a tissue site augments and accelerates thegrowth of new tissue at the tissue site. The applications of thisphenomenon are numerous, but one particular application of reducedpressure involves treating wounds. This treatment (frequently referredto in the medical community as “negative pressure wound therapy,”“reduced pressure therapy,” or “vacuum therapy”) provides a number ofbenefits, including migration of epithelial and subcutaneous tissues,improved blood flow, and micro-deformation of tissue at the wound site.Together these benefits result in increased development of granulationtissue and faster healing times. Typically, reduced pressure is appliedby a reduced pressure source to tissue through a porous pad or othermanifold device. In many instances, wound exudate and other liquids fromthe tissue site are collected within a canister to prevent the liquidsfrom reaching the reduced pressure source.

SUMMARY

The problems presented by existing reduced pressure systems are solvedby the systems and methods of the illustrative embodiments describedherein. In one embodiment, a system for applying reduced pressure to asubcutaneous tissue site is provided. The system includes a sleeve,which comprises a lumen, adapted for placement at a subcutaneous tissuesite. The sleeve includes an opening. The system further includes amanifold sized and shaped to be inserted into the lumen of the sleeve.The manifold includes at least one aperture and is operable to deliverreduced pressure to the subcutaneous tissue site through the at leastone aperture and the opening.

In another embodiment, an apparatus for applying reduced pressure to asubcutaneous tissue site includes a manifold having a distal end and aproximal end and a sleeve having a distal end and proximal end. Thesleeve is sized and shaped for placement at the subcutaneous tissuesite. The sleeve has an interior portion for receiving the manifold. Thesleeve is formed with an opening operable to transfer reduced pressurefrom the manifold to the subcutaneous tissue site. The distal end of themanifold is sized and shaped to be inserted into the interior portion ofthe sleeve. The manifold is formed with at least one aperture and isoperable to deliver reduced pressure to the subcutaneous tissue sitethrough the at least one aperture.

In still another embodiment, a method for applying reduced pressure to asubcutaneous tissue site includes inserting a sleeve at the subcutaneoustissue site such that an opening on the sleeve is adjacent thesubcutaneous tissue site. A manifold is inserted into the sleeve, themanifold including at least one aperture. Reduced pressure is suppliedto the subcutaneous tissue site via the at least one aperture and theopening.

In yet another embodiment, a method of manufacturing an apparatus forapplying reduced pressure to a subcutaneous tissue site is provided. Themethod includes forming a sleeve adapted for placement at thesubcutaneous tissue site. The sleeve is further adapted to receive amanifold and includes an opening operable to transfer reduced pressurefrom the manifold to the subcutaneous tissue site.

Other objects, features, and advantages of the illustrative embodimentswill become apparent with reference to the drawings and detaileddescription that follow.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a schematic of a reduced-pressure treatment systemfor applying reduced pressure to a subcutaneous tissue site according toan illustrative embodiment;

FIG. 2 illustrates a side view of an apparatus for applying reducedpressure to a subcutaneous tissue site according to an illustrativeembodiment;

FIG. 3 illustrates a perspective view of a distal portion of theapparatus of FIG. 2 with a portion of the apparatus shown in hiddenlines;

FIG. 4 illustrates a perspective view of the apparatus of FIG. 2;

FIG. 5 illustrates a side view of a manifold and end cap according to anillustrative embodiment;

FIG. 6 illustrates a cross-sectional front view of the end cap of FIG. 5taken at 6-6;

FIG. 7 illustrates a cross-sectional front view of the end cap of FIG. 5taken at 7-7;

FIG. 8 illustrates a cross-sectional view of a portion of the end cap ofFIG. 6 taken at 8-8; and

FIG. 9 illustrates a schematic of a reduced-pressure treatment systemfor applying reduced pressure to a tissue site in an abdominal cavity.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

In the following detailed description of several illustrativeembodiments, reference is made to the accompanying drawings that form apart hereof, and in which is shown by way of illustration specificpreferred embodiments in which the invention may be practiced. Theseembodiments are described in sufficient detail to enable those skilledin the art to practice the invention, and it is understood that otherembodiments may be utilized and that logical structural, mechanical,electrical, and chemical changes may be made without departing from thespirit or, scope of the invention. To avoid detail not necessary toenable those skilled in the art to practice the embodiments describedherein, the description may omit certain information known to thoseskilled in the art. The following detailed description is, therefore,not to be taken in a limiting sense, and the scope of the illustrativeembodiments are defined only by the appended claims.

The term “reduced pressure” as used herein generally refers to apressure less than the ambient pressure at a tissue site that is beingsubjected to treatment. In most cases, this reduced pressure will beless than the atmospheric pressure at which the patient is located.Alternatively, the reduced pressure may be less than a hydrostaticpressure associated with tissue at the tissue site. Although the terms“vacuum” and “negative pressure” may be used to describe the pressureapplied to the tissue site, the actual pressure reduction applied to thetissue site may be significantly less than the pressure reductionnormally associated with a complete vacuum. Reduced pressure mayinitially generate fluid flow in the area of the tissue site. As thehydrostatic pressure around the tissue site approaches the desiredreduced pressure, the flow may subside, and the reduced pressure is thenmaintained. Unless otherwise indicated, values of pressure stated hereinare gauge pressures. Similarly, references to increases in reducedpressure typically refer to a decrease in absolute pressure, whiledecreases in reduced pressure typically refer to an increase in absolutepressure.

Referring to FIG. 1, a reduced-pressure treatment system 100, whichapplies reduced pressure to a tissue site 103, is shown according to anillustrative embodiment. In the embodiment illustrated in FIG. 1, thetissue site 103 is a bone tissue site. In particular, the tissue site103 is a fracture on bone 106, which in the example illustrated is afemur. It is believed that reduced pressure at tissue site 103 providesa number of benefits. When used to promote bone tissue growth,reduced-pressure treatment can increase the rate of healing associatedwith a fracture, a non-union, a void, or other bone defects.Reduced-pressure treatment may also be used to improve recovery fromosteomyelitis. The treatment may further be used to increase localizedbone densities in patients suffering from osteoporosis. Finally,reduced-pressure treatment may be used to speed and improveosseointegration of orthopedic implants, such as hip implants, kneeimplants, and fixation devices.

While the tissue site 103 is bone tissue, the term “tissue site” as usedherein may refer to a wound or defect located on or within any tissue,including but not limited to, bone tissue, adipose tissue, muscletissue, neural tissue, dermal tissue, vascular tissue, connectivetissue, cartilage, tendons, or ligaments. The term “tissue site” mayfurther refer to areas of any tissue that are not necessarily wounded ordefective, but are instead areas in which it is desired to add orpromote the growth of additional tissue. For example, reduced pressuretissue treatment may be used in certain tissue areas to grow additionaltissue that may be harvested and transplanted to another tissuelocation.

Referring to FIG. 1, a reduced pressure treatment system 100 includes areduced pressure source 109 and a manifold 112 that is positioned at thetissue site 103. The reduced-pressure source 109 provides reducedpressure to tissue site 103 through the manifold 112. The manifold 112may include a passageway (not illustrated in FIG. 1) for administeringreduced pressure and removing or supplying fluids to the tissue site103. The passageway may extend from a distal end 113 of the manifold 112to a proximal end 114. The manifold 112 receives the reduced pressurefrom the reduced-pressure source 109 through a delivery conduit 115,which is in fluid communication with the manifold 112 and deliversreduced pressure to the manifold 112 during treatment. The manifold 112may include at least one aperture, such as apertures 118, and maydeliver reduced pressure to the tissue site 103 via the apertures 118.

In one illustrative embodiment, the manifold 112 may be inserted into asleeve 121 to provide reduced pressure treatment to the tissue site 103.The sleeve 121, which may be a lumen member, may extend from the tissuesite 103, through the patient's skin, and to a location external to thepatient 124. The proximal end 127 of the sleeve 121, which has anopening 130 into which the manifold 112 may be inserted, may protrudefrom the patient 124 when the sleeve 121 is placed at the tissue site103. Exposing the proximal end 127 of the sleeve 121 in this mannerfacilitates access to the sleeve 121 and the insertion of the manifold112 into the sleeve 121. The manifold 112 has a longitudinal length L1,the sleeve has a longitudinal length L2, and a distance from the tissuesite to a location external to the patient is L3. In one embodiment,L1>L2>L3. In another embodiment, the proximal end 127 of the sleeve 121may be subcutaneously disposed in the patient 124, i.e., L2<L3. Thesleeve 121 may be disposed at the tissue site 103 of a patient 124 in avariety of different spatial orientations, including the flexedorientation shown in FIG. 1. The sleeve 121 may be releasably secured toa patient 124 to hold the sleeve 121 in a fixed position with respect tothe tissue site 103 or may be unsecured. In one embodiment, the sleeve121 may be sutured into place or adhered using a medical epoxy, medicaltape, or other means. The proximal end 127 may include a flange (notshown) to prevent the proximal end 127 from entering the patient 124.Moreover, the flange might be put in a position abutting an externalportion of the patient 124 and adhered using epoxy, medical tape,sutures, etc.

The sleeve 121 is capable of slidably receiving the manifold 112. Themanifold 112 may be inserted into the opening 130 and moved toward thedistal end 133 of the sleeve 121. The manifold 112 may be placedadjacent an opening 136 in sleeve 121. The opening 136 may be located ata distal portion 139 of the sleeve 121, may run the length of the sleeve121, or may take any shape or size. The manifold 112 may include visualindicia (see by analogy 691 in FIG. 9) to help gauge the extent to whichmanifold 112 has been inserted into an interior portion of the sleeve121. An exterior portion of the manifold 112 or the interior portion ofthe sleeve 121 or both may include ribs to provide tactile feedback tothe healthcare provider regarding the relative position of the sleeve121 and the manifold 111. The manifold 112 is capable of deliveringreduced pressure from the reduced-pressure source 109 to the tissue site103 via the opening 136 in the sleeve 121.

In use, it may be desirable to releasably secure the manifold 112 to thesleeve 121. An interference fit or groove lock may be used as describedfurther below. Alternatively, the manifold 112 may include alongitudinal ridge member (not shown) that is positioned along thelength (or a portion of the length) of the manifold 112 and that mateswith a longitudinal groove (not shown) on the interior portion of thesleeve 121. Alternatively, the groove may be on the manifold 112 and theridge member on the sleeve 121. This approach to securing the manifold112 and sleeve 121 may further help assure that the manifold 112 assumesa proper position with respect to opening 136 and ultimately tissue site103.

The manifold 112 may be both insertable and removable from the sleeve121 while the sleeve 121 remains at the tissue site 103. During use, apneumatic seal may be formed about the manifold 112 and sleeve 121proximate an opening 119 in the patient 124, e.g., an opening in thepatient's skin. The pneumatic seal may be formed using a drape material,medical tape, a hydrocolloid, or other sealing members.

The manifold 112 may be moved out of the sleeve 121 at any time. Byallowing the manifold 112 to be inserted and removed from the sleeve 121while the sleeve remains at the tissue site 103, the system 100facilitates effective reduced-pressure treatment of the tissue site 103.For example, in the event that the manifold 112 becomes clogged, such asby fibrin, tissue, or any other bodily substance, the manifold 112 maybe removed from the sleeve 121 and either cleaned or replaced withanother manifold that can be inserted into the sleeve 121. Indeed, themanifold 112 may be removed or re-inserted for any reason, such as tovisually monitor the integrity of the manifold 112 or to facilitate themovement of the patient 124 by disconnecting the patient 124 from thereduced-pressure source 109. Further, the insertion and removal of themanifold 112 may be repeated any number of times while minimizing thedisruption of or damage to tissue in and around the tissue site 103 orat the skin.

In one embodiment, clogging of the manifold 112 may be reduced orprevented by delivering a purging fluid to the manifold 112. In thisembodiment, a fluid source 142 may supply a purging fluid. The deliveryconduit 115 may deliver the fluid to the manifold 112. The fluid may bea liquid or a gas, such as air, and may purge any blockages in themanifold 112. These purged substances, which may include fibrin, tissue,or any other bodily substance, are drawn out of the manifold 112 andtoward the reduced-pressure source 109 using reduced pressure from thereduced-pressure source 109. These substances may be received by acontainer 145. In another embodiment, the fluid source 142 may alsosupply antibacterial agents, antiviral agents, cell-growth promotionagents, irrigation fluids, or other chemically active agents to thetissue site 103.

In one embodiment, a method for applying reduced pressure to the tissuesite 103 includes inserting the sleeve 121 at the tissue site 103 suchthat the opening 136 on the sleeve 121 is adjacent the tissue site 103.The method may also include inserting the manifold 112, which includesapertures 118, into the sleeve 121. Reduced pressure is supplied to thetissue site 103 via the apertures 118 and the opening 136. The methodmay further include removing the manifold 112 from the sleeve 121. Inthis embodiment, the sleeve 121 may remain at the tissue site 103, andthe manifold 112, or any other manifold, may be inserted or re-insertedinto the sleeve 121. The sleeve 121 may also be removed from the tissuesite 103 at any time, with or without the manifold 112 being positionedin the sleeve 121.

In one embodiment, a method of manufacturing an apparatus for applyingreduced pressure to the tissue site 103 includes forming the sleeve 121.The method may also include forming the manifold 112.

Referring to FIGS. 2-4, an apparatus 201 for applying reduced pressureto a subcutaneous tissue site is shown in accordance with anillustrative embodiment. In particular, FIGS. 2-4 show a manifold 212and a sleeve 221, which are similar to the manifold 112 and the sleeve121 in FIG. 1, respectively. The sleeve 221 and the manifold 212 mayhave the same lateral cross-sectional shape. In FIGS. 2-4, the sleeve221 and the manifold 212 have a circular lateral cross-section. Thesleeve 221 or the manifold 212 may have other lateral cross-sectionalshapes, such as an ellipse, a polygon, an irregular shape, or acustomized shape.

The width 248 of the sleeve 221 is preferably larger than the width 251of the manifold 212. However, the width 251 of the manifold 212 is notrequired to be constant along the entire length of the manifold 219. Thewidth 251 of the manifold 212 may instead be varied along its lengthrelative to the width 248 of the sleeve 221 to increase or decrease theamount of space between the manifold 212 and the sleeve 221.

The sleeve 221 or the manifold 212 may be made from a variety ofbiocompatible materials, including silicone. The sleeve 221 may beflexible such that the sleeve 221 is bendable when inserted or disposedsubcutaneously. In one embodiment, the sleeve 221 is composed of a moreflexible material than the manifold 212. The rigidity of the manifold212 may help to prevent the collapse of the manifold 212 when exposed toreduced pressure.

The opening 236 of the sleeve 221, which is functionally analogous tothe opening 136 in FIG. 1, may be located on a wall 257, or side wall,of the sleeve 221. The opening 236 is positioned at or near the mostdistal portion 233 of sleeve 221 and expands along a length of thesleeve 221. The opening 236 is capable of transferring reduced pressurefrom the manifold 212 to a tissue site. In one embodiment, the opening236 may extend along substantially the entire length 260 of the sleeve221.

The opening 236 is shown to have a substantially rectangular shape.However, the opening 236 may have any shape, including a circular,elliptical, polygonal, irregular, or customized shape. In the example inwhich the opening 236 has a customized shape, the opening 236 may becreated based on the particular implementation or tissue site beingtreated by the apparatus 201. In addition, sleeve 221 may have two ormore openings 236. The two or more openings 236 may face the same ordifferent directions. For example, two openings 236 may be located onopposite sides of the wall 257. In another example, the two openings 236may be located on the same side of the wall 257, and may be alignedalong the length 260 of the sleeve 221. The size, shape, and number ofopenings 236 may depend on the particular tissue site and type oftreatment being implemented.

Manifold 212 includes a plurality of apertures 218 that partially orfully surround the manifold 212. In the example in which the apertures218 fully surround the manifold 212 and the manifold 212 issubstantially cylindrical, the apertures 218 may be located around thecircumference of the manifold 212. In the example in which the apertures218 partially surround the manifold 212, each of the apertures 218 maybe disposed to substantially face toward the opening 236 when themanifold 212 is inserted in the sleeve 221.

The manifold 212 may also include a flange 263, which may partially orfully surround the manifold 212. An outer edge 266 of the flange 263 mayat least partially abut an inner surface 269 of the sleeve 221 when themanifold 212 is inserted in the sleeve 221. Also, the outer edge 266 ofthe flange 263 may be slidable along the inner surface 269 of the sleeve221 when the manifold 212 is inserted into the sleeve in the directionof arrow 272 or removed in the direction of arrow 275. The flange 263may disposed anywhere along the manifold 212, including the end 278 ofthe manifold 212. Any number of flanges 263, such as two or more flanges263 may be included.

The flange 263 is capable of moving a substance, such as a bodilysubstance or fluid, toward the proximal end 227 of the sleeve 221 whenthe manifold 212 is removed from the sleeve 221 as suggested by arrow275 in FIG. 2. In this embodiment, the removal of the manifold 212 helpsto clear the sleeve 221, including the distal end 239 of the sleeve 221,of debris, such as exudate, tissue, or any other substance.

The width 281, or outer diameter, of the flange 263 may be larger thanthe width 283 of the opening 236. In this embodiment, the flange 263 mayhelp to prevent the manifold 212 from exiting the sleeve 221 through theopening 236, especially when the manifold 212 is being inserted into thesleeve 221. In an alternative embodiment (not shown), the interior ofthe sleeve 221 may including a blocking member designed to engage flange263 and stop further insertion of manifold 212 into sleeve 221.Alternatively, the manifold 212 may include a surface feature on aproximal portion that prevents further advancement of the manifold 212into sleeve 221.

In one embodiment, the flange 263 includes at least one hole, such asholes 285. The holes 285 allow fluid communication between the space 287on the distal side of the flange 263 and the space 289 on the proximalside of the flange 263. The flange 263 may include any number of holes285, and the holes 285 may have any shape. In one embodiment, the flange263 has no holes 285. In another embodiment, the holes 285 may haveone-way valves in the holes 285 that allow fluid to be pulled out of thesleeve 221 when the manifold 212 is removed, but avoid pushing air orother fluids when the manifold 212 is moved into the sleeve 221 (i.e.,the valves allow fluid flow through the valves in the direction of arrow275, but prevent flow in the direction of arrow 272).

Although the flange 263 is shown in FIG. 3 as being positioned along thelength of opening 236 when the manifold 212 is fully inserted within thesleeve 221, the flange 263 could instead be located distal to theopening 236 when the manifold 212 is fully inserted. In this particularembodiment, the positioning of the flange 263 distal to the opening 236may allow the flange 263 to better remove all bodily debris andsubstances (when the manifold is removed) that enter the sleeve 221through the opening 236.

The sleeve 221 includes an end cap 291 that is coupled to a distal end292 of the sleeve 221. As used herein, the term “coupled” includescoupling via a separate object, and also includes direct coupling. Inthe case of direct coupling, the two coupled objects touch each other insome way. The term “coupled” also encompasses two or more componentsthat are continuous with one another by virtue of each of the componentsbeing formed from the same piece of material. Also, the term “coupled”includes chemical coupling, such as via a chemical bond. The term“coupled” may also include mechanical, thermal, or electrical coupling.“Coupled” may also mean fixedly coupled or removably coupled.

The end cap 291 may prevent fluid and reduced pressure from entering orexiting the sleeve 221 at the distal end 292 of the sleeve 221. The endcap 291 may have any shape, including a rounded or dome shape. In theexample in which the end cap 291 has a rounded or dome shape, the shapeof the end cap 291 better facilitates the subcutaneous insertion of thesleeve 221. Also, the space 293 inside the end cap 291 may be eitherhollow or solid. In another embodiment, the sleeve 221 does not includethe end cap 291.

Referring more specifically to FIG. 4, a delivery conduit 215, which isfunctionally analogous to the delivery conduit 115 in FIG. 1, maydeliver reduced pressure or fluid to the manifold 212. In oneembodiment, the delivery conduit 215 may include two or more lumens,such as lumens 293 and 294. In one example, the lumen 293 deliversreduced pressure to the manifold 212, and the lumen 294 delivers a fluidto the manifold 212. The delivery conduit 215 is fluidly coupled to themanifold 212.

Referring to FIGS. 5-8, a manifold 512, which is similar to the manifold112 in FIG. 1, and an end cap 591, which is similar to the end cap 291in FIGS. 2-4, are shown in an exploded view. The sleeve to which end cap591 is coupled is not illustrated in FIG. 5 for purposes of clarity. Theend cap 591 includes a securing wall 595 on a sleeve-facing side 596 ofthe end cap 591. In one embodiment, the securing wall 595 receives thedistal end 578 of the manifold 512 such that the securing wall 595 atleast partially surrounds the distal end 578 of the manifold 512 and mayform an interference fit. Alternatively, the distal end 578 of themanifold may receive and surround the securing wall 595 and may form aninterference fit. The securing wall 595 may stabilize, secure, orprevent relative movement, e.g., lateral or longitudinal movement, ofthe manifold 512 and sleeve 521 when the manifold 512 is inserted intothe sleeve 521. The space 502 around the securing wall 595 may be hollowor solid. The end cap 591 may be dome-shaped as shown or may becylindrical, or may take any other shape.

In one embodiment, the securing wall 595 may include at least onegroove, such as groove 597, and the manifold 512 may include at leastone projection, such as projection 598, at or near the distal end 578 ofthe manifold 512. The projection 598 radially extends from the manifold512. When the distal end 578 is inserted into the securing wall 595, thegroove 597 slidably receives the projection 598. By inserting theprojection 598 into the groove 597, the manifold 512 is substantiallyprevented from rotational movement with respect to with respect to themanifold 512. When the groove 597 slidably receives the projection 598,the manifold is oriented such that the apertures 518 may face theopening (not shown) in the sleeve. By moving the projection 598 into alocking portion 599 of the groove 597, the movement of the manifold 512out of the sleeve may be hindered or prevented. In another embodiment,the groove 597 does not include the locking portion 599.

The illustrative embodiments of sleeves and manifolds may be used toprovide reduced pressure treatment to one or more tissue sites and attissue sites located at various locations within a patient. For example,the system 100 in FIG. 1 is shown applied to a tissue site 103 that is abone. In another illustrative embodiment illustrated in FIG. 9, areduced-pressure treatment system 600 is capable of providing reducedpressure to an abdominal tissue site 603.

The system 600 is analogous to system 100, and similar parts to those inFIG. 1 have been shown with reference numerals indexed by 500. Thetissue site 603 is within an abdominal cavity and in particular within aparacolic gutter 607 of a patient 624. A manifold 612 is inserted into asleeve 621. The sleeve 621 has a distal end 625 and a proximal end 627.The proximal end 627 of the sleeve 621 has an opening 630 into which themanifold 612 may be inserted. In this embodiment, there is no tissuedefect as such, and the manifold 612 is exposed to multiple tissues andtissue sites along an anatomic plane or region, in this case, theabdominal paracolic gutter 607. It should be noted that system 600 isshown applied to one paracolic gutter 607, but may be appliedbilaterally to provide reduced pressure treatment to a paracolic gutter611 on the other side of the patient 624.

The sleeve 621 is inserted through an opening in the patient's abdomenand positioned in the paracolic gutter 607. The manifold 612 is insertedinto the sleeve 621. The manifold 612 is positioned to have apertures618 proximate opening 636 and proximate tissue site 603. The proximalend 690 of the manifold 612 is coupled to a delivery conduit 615. Thedelivery conduit 615 provides reduced pressure from a reduced pressuresource 609 to remove fluids (e.g., ascites or exudates) from the tissuesite 603, which are then are collected within a container 645. Thedelivery conduit 615 may also provide a fluid from a fluid source 642.The proximal end 690 of the manifold 612 may include visual indicia 691to help the healthcare provider gauge the extent to which manifold 612has been inserted into the sleeve 621. The proximal end 690 may alsohave a flange or other device to avoid over insertion of the manifold612 into the sleeve 621.

The system 600 may be used to provide reduced pressure treatment at thewound site 603 or to only remove fluids, e.g., ascites, from theabdominal cavity. Numerous other tissue sites are also possible.

It should be apparent from the foregoing that an invention havingsignificant advantages has been provided. While the invention is shownin only a few of its forms, it is not just limited but is susceptible tovarious changes and modifications without departing from the spiritthereof.

I claim:
 1. A system for applying reduced pressure to a subcutaneoustissue site, the system comprising: a sleeve adapted for placement atthe subcutaneous tissue site, the sleeve comprising a lumen, a distalend, a proximal end, and an opening; a manifold sized and shaped to beinserted into the lumen of the sleeve, wherein the manifold comprises aplurality of apertures configured to face the opening when the manifoldis inserted into the sleeve, and wherein the manifold is operable todeliver reduced pressure to the subcutaneous tissue site through theplurality of apertures and the opening; and a flange disposed along themanifold between the distal end of the sleeve and the plurality ofapertures.
 2. The system of claim 1, further comprising: areduced-pressure source operable to supply reduced pressure and adelivery conduit in fluid communication with the manifold, the deliveryconduit operable to deliver the reduced pressure to the manifold duringtreatment.
 3. The system of claim 1, wherein the tissue site is withinan abdominal cavity.
 4. The system of claim 1, wherein the tissue siteis proximate a paracolic gutter.
 5. The system of claim 1, wherein thesleeve is formed from a flexible material.
 6. The system of claim 1,wherein the manifold comprises a fluid passageway for delivering reducedpressure.
 7. The system of claim 1, wherein the manifold comprises afluid passageway for delivering reduced pressure and wherein thepassageway extends from a distal end of the manifold to a proximal endof the manifold.
 8. The system of claim 1, wherein the manifold has alongitudinal length L1, the sleeve has a longitudinal length L2, andwherein L1>L2.
 9. The system of claim 1, wherein the manifold has alongitudinal length L1, the sleeve has a longitudinal length L2, adistance from the subcutaneous tissue site to a location external thepatient is L3, and wherein L1>L2>L3.
 10. An apparatus for applyingreduced pressure to a subcutaneous tissue site, the apparatuscomprising: a manifold having a distal end and a proximal end; a sleevehaving a distal end and a proximal end, the sleeve sized and shaped forplacement at the subcutaneous tissue site, the sleeve having an interiorportion for receiving the manifold, the sleeve formed with an openingoperable to transfer reduced pressure from the manifold to thesubcutaneous tissue site; a flange disposed between the manifold and thesleeve, the flange at least partially surrounding the manifold; andwherein the distal end of the manifold is sized and shaped to beinserted into the interior portion of the sleeve, wherein the manifoldis formed with a plurality of apertures disposed between the flange andthe proximal end of the manifold and configured to face the opening whenthe manifold is inserted into the sleeve, and wherein the manifold isoperable to deliver reduced pressure to the subcutaneous tissue sitethrough the plurality of apertures.
 11. The apparatus of claim 10,wherein the opening formed on the sleeve is located on a side wall ofthe sleeve, and wherein the opening extends along a length of thesleeve.
 12. The apparatus of claim 11, wherein the opening is locatedproximate the distal end of the sleeve.
 13. The apparatus of claim 10,wherein the sleeve is wider than the manifold.
 14. The apparatus ofclaim 10, wherein the sleeve and the manifold have the samecross-sectional shape.
 15. The apparatus of claim 10, wherein the flangecomprises: an outer edge adapted to at least partially abut the interiorportion of the sleeve.
 16. The apparatus of claim 15, wherein the outeredge of the flange is slidable along an inner surface of the sleeve. 17.The apparatus of claim 16, wherein the flange is operable to move asubstance toward a proximal end of the sleeve when the manifold isremoved from the sleeve.
 18. The apparatus of claim 15, wherein theflange includes at least one hole.
 19. The apparatus of claim 15,wherein the flange is wider than the opening.
 20. The apparatus of claim10, further comprising: an end cap coupled to a distal end of thesleeve.
 21. The apparatus of claim 20, wherein the end cap includes asecuring wall on a sleeve-facing side of the end cap, and wherein thesecuring wall is adapted to receive the distal end of the manifold suchthat the securing wall at least partially surrounds the distal end ofthe manifold.
 22. The apparatus of claim 21, wherein the manifoldfurther comprises at least one projection on the distal end of themanifold, wherein the at least one projection radially extends from themanifold, and wherein the securing wall includes at least one groovethat slidably receives the at least one projection.
 23. The apparatus ofclaim 22, wherein the plurality of apertures substantially face theopening when the at least one groove slidably receives at least oneprojection.
 24. The apparatus of claim 10, wherein the sleeve is madefrom a more flexible material than the manifold.
 25. The apparatus ofclaim 10, wherein the manifold has a longitudinal length L1, the sleevehas a longitudinal length L2, and wherein L1>L2.
 26. The apparatus ofclaim 10, wherein the manifold has a longitudinal length L1, the sleevehas a longitudinal length L2, a distance from the tissue site to alocation external the patient is L3, and wherein L1>L2>L3.